Burns Marguerite E
Department of Ambulatory Care and Prevention, Harvard Medical School, Harvard Pilgrim Health Care, Boston, MA 02215, USA.
Health Serv Res. 2009 Oct;44(5 Pt 1):1521-41. doi: 10.1111/j.1475-6773.2009.00991.x. Epub 2009 Jun 22.
To evaluate the impact of Medicaid managed care organizations (MCO) on health care access for adults with disabilities (AWDs).
Mandatory and voluntary enrollment data for AWDs in Medicaid MCOs in each county were merged with the Medical Expenditure Panel Survey and the Area Resource File for 1996-2004.
I use logit regression and two evaluation perspectives to compare access and preventive care for AWDs in Medicaid MCOs with FFS. From the state's perspective, I compare AWDs in counties with mandatory, voluntary, and no MCOs. From the enrollee's perspective, I compare AWDs who must enroll in an MCO or FFS to those who may choose between them.
Mandatory MCO enrollees are 24.9 percent more likely to wait >30 minutes to see a provider, 32 percent more likely to report a problem accessing a specialist, and 10 percent less likely to receive a flu shot within the past year. These differences persist from the state evaluation perspective.
States should not expect a dramatic change in health care access when they implement Medicaid MCOs to deliver care to the adult disabled population. However, continued attention to specialty care access is warranted for mandatory MCO enrollees.
评估医疗补助管理式医疗组织（MCO）对成年残疾人（AWD）获得医疗服务的影响。
各县医疗补助MCO中AWD的强制和自愿参保数据与1996 - 2004年医疗支出面板调查及地区资源文件合并。
我使用逻辑回归和两种评估视角，将医疗补助MCO中的AWD与按服务项目付费（FFS）方式下的AWD在获得医疗服务和预防性医疗方面进行比较。从州的角度，我比较了在有强制、自愿和无MCO的县中的AWD。从参保人的角度，我比较了那些必须参加MCO或FFS的AWD与那些可以在两者之间选择的AWD。
强制参加MCO的参保人等待超过30分钟看医生的可能性高24.9%，报告在获得专科医生服务方面有问题的可能性高32%，在过去一年中接种流感疫苗的可能性低10%。从州评估的角度来看，这些差异依然存在。
当各州实施医疗补助MCO为成年残疾人群体提供医疗服务时，不应期望在获得医疗服务方面会有巨大变化。然而，对于强制参加MCO的参保人，仍需持续关注其获得专科医疗服务的情况。
